Individual provider Active NPI

Frank A Pettisani Jr., DMD

  • General Practice Dentistry
  • Vineland, NJ
National Provider Identifier
1851482004
Registry record updated May 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
22D101824800 Issued in NJ
Practice address
1500 S Lincoln Ave
Vineland, NJ 08361
Phone
(856) 691-2553
Fax
(856) 691-3370
NPI assigned
Sep 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 22D101824800 NJ Primary

Addresses

Primary practice location

1500 S Lincoln Ave
Vineland, NJ 08361

Mailing address

1500 S Lincoln Ave
Vineland, NJ 08361
Phone (856) 691-2553

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
22D101824800NJMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Dental Care of Egg Harbor Current Accepting new patients
Dental Care of Atlantic City Current Accepting new patients
Dental Care of Mays Landing Current Accepting new patients
Dental Care of Brigantine, LLC General Practice Past Accepting new patients
Dental Care of Millville, LLC Past Accepting new patients
Sleep for Health-Medford LLC PastSince Jan 27, 2012 Accepting new patients

Locations

1500 S Lincoln Ave
Vineland, NJ 08361
Phone (856) 691-2553

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1851482004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 S LINCOLN AVE",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "08361",
            "telephone_number": "856-691-2553",
            "fax_number": "856-691-3370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 S LINCOLN AVE",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "08361",
            "telephone_number": "856-691-2553",
            "fax_number": "856-691-3370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTISANI",
        "first_name": "FRANK",
        "middle_name": "A",
        "name_suffix": "Jr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22D101824800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vineland, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.